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Kafil TS, Manian U, Tzemos N. Hybrid Mitral Valve Replacement: An Emerging Option for Nonsurgical Candidates With Complex Mitral Valve Disease. JACC Case Rep 2019; 1:500-502. [PMID: 34316864 PMCID: PMC8288990 DOI: 10.1016/j.jaccas.2019.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tahir S. Kafil
- Department of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Usha Manian
- Department of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nikolaos Tzemos
- Department of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
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52
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Fox JM, Trzcinka A, Cobey F. The Mitral/Aortic Flow Velocity Integral Ratio in Mitral Regurgitation. J Cardiothorac Vasc Anesth 2019; 34:289-293. [PMID: 31590940 DOI: 10.1053/j.jvca.2019.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 11/11/2022]
Abstract
The development of echocardiography was driven, in part, by a need to diagnose mitral regurgitation in patients undergoing finger fracture commissurotomy in the 1950s. Decades later, color Doppler became the cornerstone for noninvasive evaluation of mitral regurgitation. The authors present 2 cases of calcific mitral stenosis in which reliance on color Doppler in transthoracic echocardiography resulted in erroneous conclusions as to the severity of coexisting mitral regurgitation. The possible application of the Mitral to Aortic Flow Velocity Integral Ratio in such cases as a possible adjunct to grading mitral regurgitation is also discussed.
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Affiliation(s)
- John M Fox
- Tufts Medical Center Department of Anesthesiology, Boston, MA.
| | | | - Frederick Cobey
- Tufts Medical Center Department of Anesthesiology, Boston, MA
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53
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Carino D, Agostinelli A, El Qarra S, Gripshi F, Nicolini F. Mitral annulus calcification: current management and future challenges. Asian Cardiovasc Thorac Ann 2019; 27:565-572. [PMID: 31342756 DOI: 10.1177/0218492319867237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mitral annulus calcification is a chronic degenerative process in the fibrous base of the mitral valve. Assessment and treatment of mitral valve disease in patients with severe mitral annulus calcification is challenging, and a multimodal approach is helpful to delineate its severity and anatomic features, and to guide the therapeutic strategy. This article reviews the current literature to provide a clinically relevant description of mitral annulus calcification, analyze the diagnostic pathway of a patient with mitral annulus calcification, and summarize the therapeutic options.
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Affiliation(s)
- Davide Carino
- Cardiac Surgery Department, Parma University Hospital, Parma, Italy
| | | | - Suad El Qarra
- Cardiac Surgery Department, Parma University Hospital, Parma, Italy
| | - Florida Gripshi
- Cardiac Surgery Department, Parma University Hospital, Parma, Italy
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54
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Khan JM, Babaliaros VC, Greenbaum AB, Foerst JR, Yazdani S, McCabe JM, Paone G, Eng MH, Leshnower BG, Gleason PT, Chen MY, Wang DD, Tian X, Stine AM, Rogers T, Lederman RJ. Anterior Leaflet Laceration to Prevent Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Replacement. J Am Coll Cardiol 2019; 73:2521-2534. [PMID: 31118146 PMCID: PMC6664295 DOI: 10.1016/j.jacc.2019.02.076] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Left ventricular outflow tract (LVOT) obstruction is a leading cause of mortality and exclusion from transcatheter mitral valve replacement (TMVR). Intentional laceration of the anterior mitral valve leaflet to prevent LVOT obstruction (LAMPOON) is a transcatheter mimic of surgical chord-sparing leaflet resection. OBJECTIVES The purpose of this prospective multicenter trial was to study LAMPOON with transseptal (Edwards Lifesciences, Irvine, California) TMVR in annuloplasty rings or native mitral annular calcification (MAC). METHODS Subjects at high or extreme surgical risk and prohibitive risk of LVOT obstruction from TMVR were included. Eligibility was modified midtrial to exclude subjects with threatened LVOT obstruction from a Sapien 3 valve fabric skirt. The primary endpoint was procedure survival with successful LAMPOON, with successful TMVR, without reintervention, and with LVOT gradient <30 mm Hg ("optimal") or <50 mm Hg ("acceptable"). Secondary endpoints included 30-day mortality and major adverse cardiovascular events. There was universal source-data verification and independent monitoring. All endpoints were independently adjudicated. Central laboratories analyzed echocardiogram and CT images. RESULTS Between June 2017 and June 2018, 30 subjects were enrolled equally between the MAC and ring arms. LAMPOON traversal and midline laceration was successful in 100%. Procedure survival was 100%, and 30-day survival was 93%. Primary success was achieved in 73%, driven by additional procedures for paravalvular leak (10%) and high-skirt neo-LVOT gradients observed before a protocol amendment. There were no strokes. CONCLUSIONS LAMPOON was feasible in native and annuloplasty ring anatomies in patients who were otherwise ineligible for treatment, with acceptable safety. LAMPOON was effective in preventing LVOT obstruction from TMVR. Despite LAMPOON, TMVR using Sapien 3 in annuloplasty rings and MAC still exhibits important limitations. (NHLBI DIR LAMPOON Study: Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Implantation; NCT03015194).
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia; Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
| | | | | | | | - Gaetano Paone
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
| | - Marvin H Eng
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
| | - Bradley G Leshnower
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Patrick T Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Dee Dee Wang
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
| | - Xin Tian
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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55
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Praz F, Khalique OK, Lee R, Wu IY, Russell H, Guerrero M, Wang DD, Veeragandham R, Islam AM, Deaton DW, Kaneko T, Eudailey KW, Akkoc D, Kantor A, Wang C, Tang DCH, Park JS, Leung D, Nazif TM, Vahl TP, Hahn RT, Kodali SK, Leon MB, Takayama H, Bapat V, Borger MA, George I. Imaging in patients with severe mitral annular calcification: insights from a multicentre experience using transatrial balloon-expandable valve replacement. Eur Heart J Cardiovasc Imaging 2019; 20:1395-1406. [DOI: 10.1093/ehjci/jez050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/06/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
To investigate valve sizing and the haemodynamic relevance of the predicted left ventricular outflow tract (LVOT) in patients with mitral annular calcification (MAC) undergoing transatrial transcatheter valve implantation (THV).
Methods and results
In total, 21 patients undergoing transatrial THV, multiplanar reconstruction (MPR), maximum intensity projection (MIP), and cubic spline interpolation (CSI) were compared for MA sizing during diastole. In addition, predicted neo-LVOT areas were measured in 18 patients and correlated with the post-procedural haemodynamic dimensions. The procedure was successful in all patients (100%). Concomitant aortic valve replacement was performed in eight patients (43%) (AVR group). Sizing using MPR and MIP yielded comparable results in terms of area, perimeter, and diameter, whereas the dimensions obtained with CSI were systematically smaller. The simulated mean systolic neo-LVOT area was 133.4 ± 64.2 mm2 with an anticipated relative LVOT area reduction (neo-LVOT area/LVOT area × 100) of 59.3 ± 14.7%. The systolic relative LVOT area reduction, but not the absolute neo-LVOT area, was found to predict the peak (r = 0.69; P = 0.002) and mean (r = 0.65; P = 0.004) post-operative aortic gradient in the overall population as well as separately in the AVR (peak: r = 0.91; P = 0.002/mean: r = 0.85; P = 0.002) and no-AVR (peak: r = 0.89; P = 0.003/mean: r = 0.72; P = 0.008) groups.
Conclusion
In patients with severe MAC undergoing transatrial transcatheter valve implantation, MPR, and MIP yielded comparable annular dimensions, while values obtained with CSI tended to be systematically smaller. Mitral annular area and the average annular diameter appear to be reliable parameters for valve selection. Simulated relative LVOT reduction was found to predict the post-procedural aortic gradients.
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Affiliation(s)
- Fabien Praz
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Omar K Khalique
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Raymond Lee
- Division of Cardiothoracic Surgery, Cardiovascular Thoracic Institute, University of Southern California, Santa Monica, CA, USA
| | - Isaac Y Wu
- Department of Anesthesia, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Hyde Russell
- Division of Cardiothoracic Surgery, Evanston Hospital Northshore University HealthSystem, Evanston, IL, USA
| | - Mayra Guerrero
- Division of Cardiology, Mayo Clinic Hospital, Rochester, MN, USA
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Hospital Center for Structural Heart Disease, Detroit, MI, USA
| | | | - Ashequl M Islam
- Division of Cardiology, Baystate Medical Center, Springfield, MA, USA
| | - David W Deaton
- Division of Cardiothoracic Surgery, Baystate Medical Center, Springfield, MA, USA
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Deniz Akkoc
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Alex Kantor
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Catherine Wang
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Diane C H Tang
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Joongheum S Park
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Diana Leung
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Tamim M Nazif
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Torsten P Vahl
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Rebecca T Hahn
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Susheel K Kodali
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Martin B Leon
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Hiroo Takayama
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Vinayak Bapat
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Isaac George
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, MHB 7GN-435, 177 Ft Washington Ave, New York, NY 10032, USA
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Kassar M, Khalique OK, Pilgrim T, Reineke D, Carrel T, Windecker S, George I, Praz F. Surgical Transatrial Implantation of Transcatheter Heart Valves in Severe Mitral Annular Calcification. Interv Cardiol Clin 2019; 8:313-319. [PMID: 31078187 DOI: 10.1016/j.iccl.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Surgical mitral valve replacement in patients with severe annular calcification is a challenge for the cardiac surgeon. Surgical transatrial implantation of a transcatheter heart valve is an alternative for selected patients, in particular those at risk for obstruction of the left ventricular outflow tract or valve embolization. Herein, we review patient selection, surgical technique, and early outcomes after this novel hybrid procedure.
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Affiliation(s)
- Mohammad Kassar
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - Omar K Khalique
- Structural Heart and Valve Center, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Medical Center, 630 West 168th Street, New York City, NY 10032, USA
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - Isaac George
- Department of Cardiothoracic Surgery, New York-Presbyterian Hospital-Columbia University Medical Center, 630 West 168th Street, New York City, NY 10032, USA
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland.
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57
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Jeganathan R, Imran Hamid U, Johnston N, Owens C, Spence M, Manoharan G, Nzewi O. The role of surgical transcatheter valve implantation for the treatment of severe mitral annular calcification. J Card Surg 2019; 34:161-166. [DOI: 10.1111/jocs.14004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/15/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Reuben Jeganathan
- Department of Cardiothoracic SurgeryRoyal Victoria HospitalBelfast United Kingdom
| | - Umar Imran Hamid
- Department of Cardiothoracic SurgeryRoyal Victoria HospitalBelfast United Kingdom
| | - Nicola Johnston
- Department of CardiologyRoyal Victoria HospitalBelfast United Kingdom
| | - Colum Owens
- Department of CardiologyRoyal Victoria HospitalBelfast United Kingdom
| | - Mark Spence
- Department of CardiologyRoyal Victoria HospitalBelfast United Kingdom
| | - Ganesh Manoharan
- Department of CardiologyRoyal Victoria HospitalBelfast United Kingdom
| | - Onyekwelu Nzewi
- Department of Cardiothoracic SurgeryRoyal Victoria HospitalBelfast United Kingdom
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58
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Pal N, Weitzel N, Kertai MD. Repair, Replace, or Watchful Waiting: A Contemporary Management of Mitral Valve Disease and Its Related Conditions. Semin Cardiothorac Vasc Anesth 2019; 23:5-10. [PMID: 30791858 DOI: 10.1177/1089253218817856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nirvik Pal
- 1 Virginia Commonwealth University-Medical College of Virginia, Richmond, VA, USA
| | - Nathaen Weitzel
- 2 University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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59
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Borger MA, Holzhey DM. Open transcatheter mitral valve replacement for severe mitral annular calcification: An ideal hybrid? J Thorac Cardiovasc Surg 2019; 157:917-918. [PMID: 30638614 DOI: 10.1016/j.jtcvs.2018.11.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, University Clinic of Cardiac Surgery, Leipzig, Germany.
| | - David M Holzhey
- Department of Cardiac Surgery, Leipzig Heart Center, University Clinic of Cardiac Surgery, Leipzig, Germany
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60
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Nissen AP, Lamelas J, George I, Umana-Pizano J, Nguyen TC. Minimally invasive transatrial mitral valve replacement in mitral annular calcification. Ann Cardiothorac Surg 2018; 7:827-829. [PMID: 30598900 DOI: 10.21037/acs.2018.10.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alexander P Nissen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA.,Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Joseph Lamelas
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Heart Institute at CHI Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Isaac George
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital-College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Juan Umana-Pizano
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA
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61
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Kobsa S, Takayama H. MAC: "Mitral annular calcification" or a "modern approach to concept learning" in surgery. J Thorac Cardiovasc Surg 2018; 157:568-569. [PMID: 30107924 DOI: 10.1016/j.jtcvs.2018.06.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Serge Kobsa
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY.
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62
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Glower DD. It's not just an open or shut case. J Thorac Cardiovasc Surg 2018; 156:143. [DOI: 10.1016/j.jtcvs.2018.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
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